| NPI | 1912996364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL ME73325) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MN 63692) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2020-09-02 |